Aim: This study is designed to examine racial differences, especially within-group differences in the African American community-based on culture of origin--in l) women's use of breast cancer screening, 2) psychosocial deterrents to screening, and, 3) among those with a history of breast disease symptoms, reasons for delay in seeking diagnosis and treatment. Method: A total of 1,200 women (300 Caucasians, 300 US-born African Americans, 300 Caribbeans from the French-speaking island of Haiti, and 300 Caribbeans from the English-speaking islands) will be interviewed using an area probability sampling approach. The protocol includes the following measures: Demographics questionnaire, Breast-screening practices, Knowledge ofBreast Cancer Risk Factors Questionnaire, Cancer Worry Scale, Indigenous Health Practices, Fatalism Scale, the Network Analysis Profile, Styles of Coping and Defense, Cancer history and family history. Multiple regression will be used to test an overall model of cancer screening utilization. As well, we will construct separate regressions for each ethnic group. From the larger cohort we will also select women who have had symptoms of breast disease--whether or not they sought medical advice--for more in-depth interviews, to ascertain the psychosocial, cultural, and economic reasons for seeking or not seeking help, in order to develop models of women at risk for neglect of symptoms. We expect examination of within-group differences in health practices and compliance behaviors to shed light on specific cultural beliefs and practices that may inform health behaviors. Implications: The findings of this 4year project will have important implications for intervention programs designed to increase positive health behaviors among women from different ethnic groups within the African American community and help reduce the high morbidity and mortality in this large and growing segment of the US population.